The CMS has approved a waiver that will allow Massachusetts to overhaul its Medicaid program by putting its beneficiaries into accountable care organizations.
Starting in July, the state will move its entire Medicaid population into an ACO. The state's current system is roughly half fee-for-service and half managed care. The waiver authorizes $52.4 billion over five years and generates $29.2 billion of federal revenue for the state.
“This waiver is the first major overhaul of the MassHealth program in 20 years and includes critical reforms to promote coordinated care, hold providers accountable and offer expanded access for substance abuse disorder services driven by the opioid crisis,” Republican Gov. Charlie Baker said in a statement.
Under the waiver, there would be three coordinated-care models that involve increasing levels of risk for providers.
Members will be placed in an ACO based on which one their primary doctor chooses. Each primary-care provider can participate in only one ACO model. There will be a 90-day opt-out period that would allow members to select a new primary-care provider in a different model.
Providers in the state are supportive of the move to an ACO system, but are concerned about how new MassHealth enrollees without an existing primary-care physician will be assigned to a plan, according to an analysis by the Massachusetts Medical Society.
They also expressed disappointment about limitations to the ACO participation as there may be instances where some patients may better benefit from one model over another.
In addition to creating a statewide Medicaid ACO system, the waiver will also allow the state to use federal funds to expand residential rehabilitation service programs and fund care-coordination and recovery services for beneficiaries with substance abuse disorders.
The waiver continues to funnel federal funds into the state's hospital pool for uninsured individuals. The CMS had increasingly questioned the need of such pools following Medicaid expansion under the Affordable Care Act.
Over the next five years, Massachusetts will receive $4.8 billion to pay for uncompensated care by safety net providers.